If you're a woman over 60, are overweight, have a lot of belly fat, smoke or don't exercise much, watch out! You're at risk for metabolic disorder syndrome, which includes diabetes, hyperlipidemia and hypertension. Find out how taming high cholesterol levels and blood pressure with healthy lifestyle changes can help ward off this condition...
Being obese and diabetic is debilitating enough. But excess body fat – especially around your middle – is dangerous because it leads to a variety of other conditions like elevated cholesterol and high blood pressure.
That’s when you’re likely to have metabolic syndrome, a “constellation of various health conditions that is reflected in diabetes and heart disease,” says Kris Iyer, M.D., executive medical director of Mary & Dick Allen Diabetes Center at Hoag Memorial Presbyterian Hospital in Newport Beach, Calif.
Metabolic syndrome affects one in five people in the U.S., and the risks of developing the syndrome increase with age.
In fact, women 60 years and older are more than six times likelier to have metabolic syndrome than those who are younger than 40 years old, according to the Centers for Disease Control and Prevention. One reason may be their lower levels of estrogen, which influences triglycerides and high-density (HDL, or “good” cholesterol) and low-density (LDL) lipoproteins in the bloodstream, according to a 2010 National Institutes of Health study.
Hyperlipidemia – high cholesterol levels – and hypertension – high blood pressure – can be treated effectively with medication, but changing your lifestyle also can dramatically improve your numbers, Iyer says.
“When detected early, [metabolic syndrome] can be managed to reduce various complications,” he says.
In this Lifescript exclusive interview, Iyer offers advice to prevent or reduce these warning signs of heart disease.
How is metabolic syndrome diagnosed?
The standard [diagnosis] requires that three of the four following issues be present:
Abdominal obesity – which is more than 40 inches in men and 35 inches in women
A triglyceride level of higher than 150 HDL (high-density lipoprotein), which is a type of cholesterol in the blood that should be less than 50
Blood pressure of 130 over 85
Fasting blood glucose of more than 100
Why are high cholesterol levels such a huge factor?
Elevated triglycerides, a chemical in the blood, are associated with hyperlipidemia [and] cardiovascular disease.
What are the symptoms?
Symptoms may be nonexistent.
But if you go to your doctor, you might be told that you’re overweight or obese and you have high blood pressure along with the other criteria.
Often, we don't have to wait for the symptoms to appear [before beginning treatment].
So regular checkups are a must?
That’s right. Prevention can delay the onset of these conditions. When detected early, [metabolic syndrome] can be managed to reduce various complications.
Autoimmune diseases are more prevalent in women than men. Is that true with metabolic syndrome?
The answers vary. Prevalence is about 22% in the country – with 27% men, 16% women.
The numbers change with people of different ethnicities, and it increases with age and in other ways.
What ethnicities or age groups are more susceptible to metabolic syndrome?
Latinos, African-Americans, Asian Indians and Arabs all are at a higher risk, and [metabolic syndrome] can be detected in the young children in those groups.
Being overweight is the most important clinical observation.
How dramatic are the differences?
Among Mexican-Americans, [the incidence of metabolic syndrome] is much higher among women than men in that group: 50% are females and 31% males.
It's the same for African-Americans: 57% of females vs. 27% of men.
It changes with the type of population and socioeconomic status.
How does aging affect metabolic syndrome?
As you get older, [the risk of metabolic syndrome] gets worse because some of the associated risk factors are present in postmenopausal women, like added girth in the abdominal area and elevated sugar levels.
In those who aren't overweight, the incidence of metabolic syndrome is 5% or less. The more overweight you are, the higher your risk.
Low income and socioeconomic [factors also] matter.
What do income and socioeconomic conditions have to do with the condition?
Lack of exercise and soft-drink consumption is higher in lower-income families. Bad habits – smoking, a high carbohydrate diet, drinking alcohol – all have a [detrimental] effect.
So do genetic factors.
Is excess weight the biggest factor in the onset of hyperlipidemia?
Excessive weight increases your risk for all the other problems [of metabolic syndrome].
If you start with exercise and a healthy diet, you’ll probably not gain weight or have [hyperlipidemia or hypertension].
Lifestyle goes a long way toward minimizing the problems.
I have patients who’ve lost 50-65 pounds and they’re off medications.
How can lifestyle help in preventing metabolic syndrome?
If you exercise, live a healthy life, have low stress, eat regularly, well and healthy, and don’t smoke, you can prevent blood pressure from going up.
If you have obesity and lose [weight], you can lower and change your [high cholesterol levels].
When a person isn’t overweight but has fat around the abdomen, are they at risk for metabolic syndrome?
Abdominal girth, or central abdominal obesity, as we doctors call it, is a major risk factor, along with total weight.
Are more people becoming aware of metabolic syndrome, diabetes and heart disease?
I saw an 18-year-old kid last week and asked him, “What are you doing here?”
[He replied,] “I want to prevent diabetes.”
A community-based approach of making lifestyle changes based on an individual's socioeconomic levels and culture is key to helping patients understand the problem [and fight it].
What do you tell patients who are reluctant to change their lifestyle?
I wouldn't blame my patients who gain weight and make them feel bad.
Recent reports suggest that we may have conditions which genetically predispose us to want to eat more and are unable to control weight.
Something with genetics may prevent you from eating properly or [make you] more susceptible to gaining weight.
So we must give allowance to an unknown genetic or another factor that prevents them from doing what they should do.
How do you treat such patients?
It's not always easy to change your lifestyle, [especially] as you grow older and have established habits.
At Hoag’s diabetes center, we’re going to have a program to promote lifestyle changes in the community.
There's a lot to be said for dealing with the early stages of the illness and understanding how to maintain a healthy lifestyle.
What about using medication to control hyperlipidemia and hypertension?
If you notice, I haven’t talked about controlling any of the conditions with medication. Significant lifestyle changes help to maintain a good life.
We can delay the onset of type 2 diabetes if we change our lifestyle. There’s no question that blood pressure will come down and cholesterol count will change if we eat healthy.
Our grandparents told us that prevention is better than paying the doctor.
When is medication appropriate to control hyperlipidemia and hypertension?
Lifestyle changes aren’t easy, but if you have to use medication, you must. Medicine for high cholesterol levels and blood pressure reduction isn’t only acceptable, it’s strongly advisable.
High blood pressure, high cholesterol, high blood sugar must always be ruthlessly controlled, because reduction in those [levels] definitely improves the chances of you avoiding a major catastrophe like heart attack or diabetes.
Heart disease is still the single most common disease of [death] in this country, even though the incidence of heart disease has come down.
What's the most important message for patients with diabetes or at risk of metabolic disorder syndrome?
The single most important message is a healthy lifestyle from very early [in life], especially if you are at high risk. That includes exercise, and if the doctor tells you your blood pressure is high, please take the medication, and don’t smoke.
I wish I could go into everybody’s mind and tell them, “Listen to your doctor and you’ll be fine.”
What's the latest research on metabolic syndrome?
There’s a lot of research on whether it’s the number of fat cells or the size of them that [influences metabolic syndrome].
There are chemicals that come out of fat cells that appear to increase the risk of heart disease. Not all of them have been confirmed to be responsible for the heart disease.
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